Brüggemann A, Müller M
Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Lübeck.
Klin Monbl Augenheilkd. 2012 Nov;229(11):1118-23. doi: 10.1055/s-0032-1315100. Epub 2012 Sep 7.
Due to increasing cost pressure in the public health system treatments and their costs are highly relevant in the therapy for chronic diseases such as glaucoma. In the era of diagnosis-related group (DRG) reimbursement, new interventions need to prove not only their safety and effectiveness but also their cost-utility. Canaloplasty as a new interventional surgery is compared to trabeculectomy (TE) by means of a cost and effort analysis.
In this retrospective, consecutive case series patients were compared as follows: group I, 21 eyes of 21 patients undergoing canaloplasty from 2009 on and group II, 48 eyes of 42 patients, who were treated with TE with mitomycin C (MMC) from 2001 to 2004 and had intensified postoperative care. Data regarding demography, duration of hospitalisation, duration of surgery, surgical complications and interventions, and pre- and post-operative IOP were analysed within the first 6 months post operation.
In group I mean duration of hospitalisation was 5.3 ± 0.8 days (d) and in group II 10.7 ± 2.8 d. Duration of surgery was 77 ± 14 min in group I and in group II 48 ± 11 min. On average 2.8 ± 1.0 visits were needed during follow-up in group I and 6 ± 1.5 visits in group II. The mean preoperative IOP of 28.75 ± 9.6 mmHg was lowered to 12.8 ± 3.3 mmHg after six months in group I and in group II from 34.5 ± 13.4 mmHg to 10.3 ± 4.5 mmHg. In group I, a total of 4 interventions were seen within the first six months without re-admission. In group II 107 interventions and eleven re-admissions were necessary. Mean costs for hospitalisation amount to 821.50 € in group I and 1658.50 € in group II. Overall expenses were 2379.62 € for canaloplasty and 2733.61 € for TE.
Both interventions could effectively control IOP. However, trabeculectomy requires a longer hospitalisation, has higher re-admission rates and needs more frequent postoperative controls, which makes TE more costly and time-consuming than canaloplasty.
由于公共卫生系统成本压力不断增加，治疗方法及其成本在青光眼等慢性病治疗中高度相关。在诊断相关分组（DRG）付费时代，新的干预措施不仅需要证明其安全性和有效性，还需要证明其成本效益。通过成本和工作量分析，将作为一种新的介入手术的睫状体光凝术与小梁切除术（TE）进行比较。
在这个回顾性连续病例系列中，患者按以下方式进行比较：第一组，2009年起21例患者的21只眼接受睫状体光凝术；第二组，2001年至2004年接受丝裂霉素C（MMC）小梁切除术并加强术后护理的42例患者的48只眼。分析术后前6个月内有关人口统计学、住院时间、手术时间、手术并发症及干预措施以及术前和术后眼压的数据。
第一组平均住院时间为5.3±0.8天，第二组为10.7±2.8天。第一组手术时间为77±14分钟，第二组为48±11分钟。随访期间第一组平均需要2.8±1.0次就诊，第二组为6±1.5次。第一组术前平均眼压28.75±9.6mmHg，6个月后降至12.8±3.3mmHg；第二组术前眼压34.5±13.4mmHg，降至10.3±4.5mmHg。第一组在前6个月内共进行了4次干预且无再次入院情况。第二组需要107次干预和11次再次入院。第一组住院平均费用为821.50欧元，第二组为1658.50欧元。睫状体光凝术总费用为2379.62欧元，小梁切除术为2733.61欧元。
两种干预措施均可有效控制眼压。然而，小梁切除术需要更长的住院时间，再入院率更高，术后需要更频繁的检查，这使得小梁切除术比睫状体光凝术成本更高且更耗时。
